One of the most common mesh complications is mesh erosion, also called mesh exposure or extrusion. This occurs when the synthetic material placed to support pelvic tissues gradually works its way into surrounding structures. The mesh may become exposed through the vaginal lining or, less commonly, erode into adjacent organs such as the bladder, rectum, or urethra. The FDA has issued safety communications outlining these potential complications.

Another mesh complication is mesh shrinkage or contraction. In some cases, mesh placed to support the bladder or rectum can contract over time, placing tension on surrounding tissues, including the vaginal wall. Infection, chronic inflammation, or seroma formation may also occur.

Symptoms vary from patient to patient, but certain patterns are common.

Persistent vaginal pain or burning is often one of the earliest signs. It may feel like rawness, sharpness, or constant irritation that was not present before. Some women describe it as feeling like something is scratching internally.

Pain with intercourse is another frequent complaint. Partners may feel a sharp or rough sensation during intimacy. In other cases, the patient experiences deep or superficial pain that gradually worsens.

Unexplained vaginal bleeding or spotting can occur, even years after surgery. Women may notice bleeding unrelated to their menstrual cycle, bleeding with intercourse, or postmenopausal bleeding. This may result from mesh irritating or penetrating vaginal tissue. Recurrent infections or abnormal discharge may develop because exposed mesh can act as a foreign body, triggering chronic inflammation.

If erosion involves the bladder or urethra, patients may develop urinary urgency, frequency, pain with urination, recurrent urinary tract infections, urinary incontinence, or difficulty emptying the bladder.

Mesh complications do not necessarily mean the original surgery was performed incorrectly. Several factors can contribute, including tissue thinning over time (especially after menopause), smoking, impaired wound healing, chronic inflammation, mechanical tension on the mesh, and individual variation in tissue response to foreign material. As with any implanted device, some patients may have a stronger inflammatory response than others.

One of the more concerning aspects of mesh complications is delayed recognition. Early symptoms are often nonspecific and mild. Imaging studies may be inconclusive. As a result, patients are sometimes reassured that their discomfort is unrelated to prior surgery. However, pelvic pain that begins after mesh placement, particularly pain during intercourse, new bleeding, or persistent discharge, warrants careful evaluation. ACOG has published committee guidance regarding the evaluation of mesh complications ACOG committee guidance. A thorough pelvic examination by a clinician experienced in diagnosing mesh-related problems is often diagnostic. In some cases, cystoscopy, pelvic ultrasound, or additional testing may be necessary.

Management options depend on the extent and severity of the problem. Small, superficial exposures may respond to topical estrogen therapy in postmenopausal patients. Limited trimming of exposed mesh may be appropriate in selected cases. When symptoms are persistent, extensive, or involve adjacent organs, surgical mesh removal may be required. AUGS has issued joint position statements outlining management considerations.

Mesh removal surgery can be complex. Mesh may involve multiple organs, and scar tissue often forms around the implant. Complete removal must balance symptom relief with preservation of pelvic support and bladder function. In more complicated cases, a multidisciplinary approach may be necessary.

Beyond the physical symptoms, there is often an emotional toll. Many women with mesh complications, particularly those with chronic pain, feel dismissed or frustrated after months or years without clear answers. Chronic pelvic pain, especially when it affects intimacy or urinary function, can erode confidence, strain relationships, and significantly impact quality of life. Mental and emotional well-being are often affected as well.

If you have had vaginal mesh placement and are experiencing persistent pelvic pain, pain with intercourse, unexplained bleeding, recurrent urinary symptoms, or a sensation of something sharp or protruding, a thorough evaluation is appropriate. Mesh complications may be contributing to your symptoms. With accurate diagnosis and appropriate management, many patients experience meaningful improvement.

Frequently Asked Questions (FAQ)

How common is mesh erosion?

Rates vary depending on the type of mesh and surgical approach. Vaginally placed mesh historically carried higher exposure rates than abdominally placed mesh. While not every patient develops complications, erosion is well-documented in medical literature.

Can mesh erosion happen years after surgery?

Yes. Some patients develop symptoms within months, while others present several years after the original procedure.

Will imaging show mesh erosion?

Not always. A detailed pelvic examination is often more informative. If the bladder or urethra is involved, cystoscopy may be necessary.

Is mesh removal always required?

No. Small, asymptomatic exposures may be managed conservatively. However, persistent pain, bleeding, urinary symptoms, or partner discomfort typically require intervention.

If the mesh is removed, will prolapse or leakage return?

It can. This risk should be discussed before surgery. In some cases, alternative reconstructive options can be considered at the time of removal.

Is removal surgery risky?

Revision surgery is often more complex than the original procedure due to scar tissue and involvement of surrounding organs. It should be performed by a surgeon experienced in pelvic reconstructive and mesh revision surgery.

When should I seek a second opinion?

If symptoms began after mesh placement and are ongoing, worsening, or affecting your quality of life, particularly if your concerns have been minimized, seeking evaluation by a specialist is reasonable.

To schedule a consultation about mesh complications with Dr. Michael Tahery, please call 310-446-4440 or 818-265-9499 for appointments in Los Angeles or Glendale.

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